Purdue v. NaphCare

Opinion

1 JL 2 WO 3 4 5 8 9 Jacob James Purdue, No. CV-25-01430-PHX-JAT (DMF) 10 Plaintiff, 11 v. ORDER 12 NaphCare, et al., 13 Defendants.

15 On April 29, 2025, pro se Plaintiff Jacob James Purdue, who is confined in a 16 Maricopa County Jail and is proceeding in forma pauperis, filed a pro se civil rights 17 Complaint pursuant to 42 U.S.C. § 1983. In a September 5, 2025 Order, the Court 18 dismissed the Complaint because Plaintiff had failed to state a claim. The Court gave 19 Plaintiff 30 days to file an amended complaint that cured the deficiencies identified in the 20 Order. 21 On September 22, 2025, Plaintiff filed his First Amended Complaint (Doc. 7). The 22 Court will dismiss the First Amended Complaint with leave to amend. 23 I. Statutory Screening of Prisoner Complaints 24 The Court is required to screen complaints brought by prisoners seeking relief 25 against a governmental entity or an officer or an employee of a governmental entity. 28 26 U.S.C. § 1915A(a). The Court must dismiss a complaint or portion thereof if a plaintiff 27 has raised claims that are legally frivolous or malicious, fail to state a claim upon which 28 relief may be granted, or seek monetary relief from a defendant who is immune from such 1 relief. 28 U.S.C. § 1915A(b)(1)–(2). 2 A pleading must contain a “short and plain statement of the claim showing that the 3 pleader is entitled to relief.” Fed. R. Civ. P. 8(a)(2) (emphasis added). While Rule 8 does 4 not demand detailed factual allegations, “it demands more than an unadorned, the- 5 defendant-unlawfully-harmed-me accusation.” Ashcroft v. Iqbal, 556 U.S. 662, 678 6 (2009). “Threadbare recitals of the elements of a cause of action, supported by mere 7 conclusory statements, do not suffice.” Id. 8 “[A] complaint must contain sufficient factual matter, accepted as true, to ‘state a 9 claim to relief that is plausible on its face.’” Id. (quoting Bell Atlantic Corp. v. Twombly, 10 550 U.S. 544, 570 (2007)). A claim is plausible “when the plaintiff pleads factual content 11 that allows the court to draw the reasonable inference that the defendant is liable for the 12 misconduct alleged.” Id. “Determining whether a complaint states a plausible claim for 13 relief [is] . . . a context-specific task that requires the reviewing court to draw on its judicial 14 experience and common sense.” Id. at 679. Thus, although a plaintiff’s specific factual 15 allegations may be consistent with a constitutional claim, a court must assess whether there 16 are other “more likely explanations” for a defendant’s conduct. Id. at 681. 17 But as the United States Court of Appeals for the Ninth Circuit has instructed, courts 18 must “continue to construe pro se filings liberally.” Hebbe v. Pliler, 627 F.3d 338, 342 19 (9th Cir. 2010). A “complaint [filed by a pro se prisoner] ‘must be held to less stringent 20 standards than formal pleadings drafted by lawyers.’” Id. (quoting Erickson v. Pardus, 551 21 U.S. 89, 94 (2007) (per curiam)). 22 If the Court determines that a pleading could be cured by the allegation of other 23 facts, a pro se litigant is entitled to an opportunity to amend a complaint before dismissal 24 of the action. See Lopez v. Smith, 203 F.3d 1122, 1127-29 (9th Cir. 2000) (en banc). The 25 Court will dismiss Plaintiff’s First Amended Complaint for failure to state a claim, but 26 because it may possibly be amended to state a claim, the Court will dismiss it with leave 27 to amend. 28 . . . . 1 II. First Amended Complaint 2 In his three-count First Amended Complaint, Plaintiff sues NaphCare and Arizona 3 Department of Corrections, Rehabilitation and Reentry Director Ryan Thornell. Plaintiff 4 brings claims regarding his medical care, basic necessities, and retaliation. He seeks 5 injunctive and monetary relief. 6 In Count One, Plaintiff alleges that in November 2023, he became violently ill and 7 submitted a health needs request (HNR) but was never called to the medical unit. He 8 asserts that after submitting multiple HNRs and “pleas” to nurses, in March 2024, he was 9 called to chronic care, where he demanded to see the “active” nurse. Plaintiff claims that 10 the nurse took his vital signs, determined he was sick, and tested him for pneumonia and 11 COVID-19, which were negative. Plaintiff alleges he was “issued” breathing treatments 12 until he could see a doctor, but 95% of the time, he was refused breathing treatments 13 because no staff were available to escort him to the medical unit. 14 Plaintiff asserts that in April 2024, he began to rapidly lose weight and submitted 15 an emergency medical grievance, which was ignored. He claims he then “attempted 16 another” when he began losing consciousness and coughing “so violently [that he] was 17 becoming violently sick.” Plaintiff alleges that in May 2024, he had a friend contact and 18 the Assistant Director in the medical unit, demanding that Plaintiff undergo tests. Plaintiff 19 asserts that in June 2024, his heart and lungs were tested, and he tested positive for valley 20 fever. Plaintiff claims he was prescribed fluconazole, which he began taking in late June 21 or early July 2024, and an inhaler. 22 As his injury, Plaintiff alleges he suffered severe mental trauma, extreme weight 23 loss, continued shortness of breath, loss of appetite, loss of sleep, painful rashes, scarred 24 lungs, and mental and emotional distress. 25 Plaintiff designates Count Two as a claim regarding basic necessities under the 26 Eighth and Fourteenth Amendments. Plaintiff alleges that he tested positive for valley 27 fever in June 2024 and was prescribed fluconazole. He asserts that on September 3, 2024, 28 he was moved to maximum security and “refused [his] medication” and his inhaler until 1 late October 2024, after he was transferred to a different maximum-security facility. As 2 his injury, Plaintiff claims he suffered increased inflamed rashes, shortness of breath, 3 continued weight loss, and mental and emotional stress. 4 Plaintiff designates Count Three as a retaliation claim under the Eighth and 5 Fourteenth Amendments. Plaintiff alleges that on September 3, 2024, he was “moved to 6 max” in connection with a separate incident and was “denied medication as a direct result 7 of [his] transfer.” He asserts he did not receive his valley fever medication or his inhaler 8 until mid to late October “as a direct result of [a] separate incident.” As his injury, Plaintiff 9 claims he suffered increased inflammation of a rash, continued shortness of breath, weight 10 loss, loss of sleep, and mental and emotional distress. 11 III. Failure to State a Claim 12 A. Defendant NaphCare 13 To state a claim under § 1983 against a private entity performing a traditional public 14 function, such as providing medical care to prisoners, a plaintiff must allege facts to support 15 that his constitutional rights were violated as a result of a policy, decision, or custom 16 promulgated or endorsed by the private entity. See Tsao v. Desert Palace, Inc., 698 F.3d 17 1128, 1138-39 (9th Cir. 2012); Buckner v. Toro, 116 F.3d 450, 452 (11th Cir. 1997) (per 18 curiam). A plaintiff must allege the specific policy or custom and how it violated his 19 constitutional rights. A private entity is not liable merely because it employs persons who 20 allegedly violated a plaintiff’s constitutional rights. See Tsao, 698 F.3d at 1139; Buckner, 21 116 F.3d at 452. 22 Plaintiff does not allege that any of the conduct described in the Complaint was the 23 result of a specific policy or custom of Defendant NaphCare. Plaintiff makes no allegations 24 at all against NaphCare. Thus, the Court will dismiss Defendant NaphCare without 25 prejudice. 26 B. Defendant Thornell 27 To state a valid claim under § 1983, plaintiffs must allege that they suffered a 28 specific injury as a result of specific conduct of a defendant and show an affirmative link 1 between the injury and the conduct of that defendant. See Rizzo v. Goode, 423 U.S. 362, 2 371-72, 377 (1976). There is no respondeat superior liability under § 1983, and therefore, 3 a defendant’s position as the supervisor of persons who allegedly violated Plaintiff’s 4 constitutional rights does not impose liability. Monell v. Dep’t of Soc. Servs., 436 U.S. 658 5 (1978); Hamilton v. Endell, 981 F.2d 1062, 1067 (9th Cir. 1992); Taylor v. List, 880 F.2d 6 1040, 1045 (9th Cir. 1989). “Because vicarious liability is inapplicable to Bivens and 7 § 1983 suits, a plaintiff must plead that each Government-official defendant, through the 8 official’s own individual actions, has violated the Constitution.” Iqbal, 556 U.S. at 676. 9 Plaintiff has not alleged that Defendant Thornell personally participated in a 10 deprivation of Plaintiff’s constitutional rights, was aware of a deprivation and failed to act, 11 or formed policies that resulted in Plaintiff’s injuries. Plaintiff makes no allegations at all 12 against Thornell. Thus, the Court will dismiss Defendant Thornell without prejudice. 13 IV. Leave to Amend 14 For the foregoing reasons, the Court will dismiss Plaintiff’s First Amended 15 Complaint for failure to state a claim upon which relief may be granted. Within 30 days, 16 Plaintiff may submit a second amended complaint to cure the deficiencies outlined above. 17 The Clerk of Court will mail Plaintiff a court-approved form to use for filing a second 18 amended complaint. If Plaintiff fails to use the court-approved form, the Court may strike 19 the second amended complaint and dismiss this action without further notice to Plaintiff. 20 Plaintiff must clearly designate on the face of the document that it is the “Second 21 Amended Complaint.” The second amended complaint must be retyped or rewritten in its 22 entirety on the court-approved form and may not incorporate any part of the original 23 Complaint or First Amended Complaint by reference. Plaintiff may include only one claim 24 per count. 25 A second amended complaint supersedes the original Complaint and First Amended 26 Complaint. Ferdik v. Bonzelet, 963 F.2d 1258, 1262 (9th Cir. 1992); Hal Roach Studios v. 27 Richard Feiner & Co., 896 F.2d 1542, 1546 (9th Cir. 1990). After amendment, the Court 28 will treat the original Complaint and First Amended Complaint as nonexistent. Ferdik, 1 963 F.2d at 1262. Any cause of action that was raised in the original Complaint or First 2 Amended Complaint and that was voluntarily dismissed or was dismissed without 3 prejudice is waived if it is not alleged in a second amended complaint. Lacey v. Maricopa 4 County, 693 F.3d 896, 928 (9th Cir. 2012) (en banc). 5 If Plaintiff files a second amended complaint, he must write short, plain statements 6 telling the Court: (1) the constitutional right he believes was violated; (2) the name of the 7 Defendant who violated the right; (3) exactly what that Defendant did or failed to do; 8 (4) how the action or inaction of that Defendant is connected to the violation of Plaintiff’s 9 constitutional right; and (5) what specific injury Plaintiff suffered because of that 10 Defendant’s conduct. See Rizzo, 423 U.S. at 371-72, 377. 11 Plaintiff must repeat this process for each person he names as a Defendant. If 12 Plaintiff fails to affirmatively link the conduct of each named Defendant with the specific 13 injury suffered by Plaintiff, the allegations against that Defendant will be dismissed for 14 failure to state a claim. Conclusory allegations that a Defendant or group of 15 Defendants has violated a constitutional right are not acceptable and will be 16 dismissed. 17 If Plaintiff files a second amended complaint, he should note that not every claim 18 by a prisoner relating to inadequate medical treatment states a violation of the Eighth 19 Amendment. To state a § 1983 medical claim, a plaintiff must show (1) a “serious medical 20 need” by demonstrating that failure to treat the condition could result in further significant 21 injury or the unnecessary and wanton infliction of pain and (2) the defendant’s response 22 was deliberately indifferent. Jett v. Penner, 439 F.3d 1091, 1096 (9th Cir. 2006). 23 “Deliberate indifference is a high legal standard.” Toguchi v. Chung, 391 F.3d 24 1051, 1060 (9th Cir. 2004). To act with deliberate indifference, a prison official must both 25 know of and disregard an excessive risk to inmate health; “the official must both be aware 26 of facts from which the inference could be drawn that a substantial risk of serious harm 27 exists, and he must also draw the inference.” Farmer v. Brennan, 511 U.S. 825, 837 (1994). 28 Deliberate indifference in the medical context may be shown by a purposeful act or failure 1 to respond to a prisoner’s pain or possible medical need and harm caused by the 2 indifference. Jett, 439 F.3d at 1096. Deliberate indifference may also be shown when a 3 prison official intentionally denies, delays, or interferes with medical treatment or by the 4 way prison doctors respond to the prisoner’s medical needs. Estelle v. Gamble, 429 U.S. 5 97, 104-05 (1976); Jett, 439 F.3d at 1096. 6 Deliberate indifference is a higher standard than negligence or lack of ordinary due 7 care for the prisoner’s safety. Farmer, 511 U.S. at 835. “Neither negligence nor gross 8 negligence will constitute deliberate indifference.” Clement v. Cal. Dep’t of Corr., 220 F. 9 Supp. 2d 1098, 1105 (N.D. Cal. 2002); see also Broughton v. Cutter Labs., 622 F.2d 458, 10 460 (9th Cir. 1980) (mere claims of “indifference,” “negligence,” or “medical malpractice” 11 do not support a claim under § 1983). “A difference of opinion does not amount to 12 deliberate indifference to [a plaintiff’s] serious medical needs.” Sanchez v. Vild, 891 F.2d 13 240, 242 (9th Cir. 1989). A mere delay in medical care, without more, is insufficient to 14 state a claim against prison officials for deliberate indifference. See Shapley v. Nev. Bd. of 15 State Prison Comm’rs, 766 F.2d 404, 407 (9th Cir. 1985). The indifference must be 16 substantial. The action must rise to a level of “unnecessary and wanton infliction of pain.” 17 Estelle, 429 U.S. at 105. 18 V. Warnings 19 A. Release 20 If Plaintiff is released while this case remains pending, and the filing fee has not 21 been paid in full, Plaintiff must, within 30 days of his release, either (1) notify the Court 22 that he intends to pay the unpaid balance of his filing fee within 120 days of his release or 23 (2) file a non-prisoner application to proceed in forma pauperis. Failure to comply may 24 result in dismissal of this action. 25 B. Address Changes 26 Plaintiff must file and serve a notice of a change of address in accordance with Rule 27 83.3(d) of the Local Rules of Civil Procedure. Plaintiff must not include a motion for other 28 relief with a notice of change of address. Failure to comply may result in dismissal of this 1 action. 2 C. Possible “Strike” 3 Because the First Amended Complaint has been dismissed for failure to state a 4 claim, if Plaintiff fails to file a second amended complaint correcting the deficiencies 5 identified in this Order, the dismissal may count as a “strike” under the “3-strikes” 6 provision of 28 U.S.C. § 1915(g). Under the 3-strikes provision, a prisoner may not bring 7 a civil action or appeal a civil judgment in forma pauperis under 28 U.S.C. § 1915 “if the 8 prisoner has, on 3 or more prior occasions, while incarcerated or detained in any facility, 9 brought an action or appeal in a court of the United States that was dismissed on the 10 grounds that it is frivolous, malicious, or fails to state a claim upon which relief may be 11 granted, unless the prisoner is under imminent danger of serious physical injury.” 28 12 U.S.C. § 1915(g). 13 D. Possible Dismissal 14 If Plaintiff fails to timely comply with every provision of this Order, including these 15 warnings, the Court may dismiss this action without further notice. See Ferdik, 963 F.2d 16 at 1260-61 (a district court may dismiss an action for failure to comply with any order of 17 the Court). 18 IT IS ORDERED: 19 (1) The First Amended Complaint (Doc. 7) is dismissed for failure to state a 20 claim. Plaintiff has 30 days from the date this Order is filed to file a second amended 21 complaint in compliance with this Order. 22 (2) If Plaintiff fails to file a second amended complaint within 30 days, the Clerk 23 of Court must, without further notice, enter a judgment of dismissal of this action with 24 prejudice that states that the dismissal may count as a “strike” under 28 U.S.C. § 1915(g) 25 and deny any pending unrelated motions as moot. 26 . . . . 27 . . . . 28 1 (3) The Clerk of Court must mail Plaintiff a court-approved form for filing a civil 2 rights complaint by a prisoner. 3 Dated this 6th day of October, 2025. 4

° 7 James A. Teil Org Senior United States District Judge 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Instructions for a Prisoner Filing a Civil Rights Complaint in the United States District Court for the District of Arizona

1. Who May Use This Form. The civil rights complaint form is designed to help incarcerated persons prepare a complaint seeking relief for a violation of their federal civil rights. These complaints typically concern, but are not limited to, conditions of confinement. This form should not be used to challenge your conviction or sentence. If you want to challenge a state conviction or sentence, you should file a petition under 28 U.S.C. ' 2254 for a writ of habeas corpus by a person in state custody. If you want to challenge a federal conviction or sentence, you should file a motion under 28 U.S.C. § 2255 to vacate sentence in the federal court that entered the judgment. 2. The Form. Local Rule of Civil Procedure (LRCiv) 3.4 provides that complaints by incarcerated persons must be filed on the court-approved form. The form must be typed or neatly handwritten. The form must be completely filled in to the extent applicable. All questions must be answered clearly and concisely in the appropriate space on the form. If needed, you may attach additional pages, but no more than fifteen additional pages, of standard letter-sized paper. You must identify which part of the complaint is being continued and number all pages. If you do not fill out the form properly, you will be asked to submit additional or corrected information, which may delay the processing of your action. You do not need to cite law. 3. Your Signature. You must tell the truth and sign the form. If you make a false statement of a material fact, you may be prosecuted for perjury. 4. The Filing and Administrative Fees. The total fees for this action are $405.00 ($350.00 filing fee plus $55.00 administrative fee). If you are unable to immediately pay the fees, you may request leave to proceed in forma pauperis. Please review the “Information for Prisoners Seeking Leave to Proceed with a (Non-Habeas) Civil Action in Federal Court In Forma Pauperis Pursuant to 28 U.S.C. ' 1915” for additional instructions. 5. Original and Judge=s Copy. You must send an original plus one copy of your complaint and of any other documents submitted to the Court. You must send one additional copy to the Court if you wish to have a file-stamped copy of the document returned to you. All copies must be identical to the original. Copies may be legibly handwritten. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. 6. Where to File. You should file your complaint in the division where you were confined when your rights were allegedly violated. See LRCiv 5.1(a) and 77.1(a). If you were confined in Maricopa, Pinal, Yuma, La Paz, or Gila County, file in the Phoenix Division. If you were confined in Apache, Navajo, Coconino, Mohave, or Yavapai County, file in the Prescott Division. If you were confined in Pima, Cochise, Santa Cruz, Graham, or Greenlee County, file in the Tucson Division. Unless you are an inmate housed at an Arizona Department of Corrections facility that participates in electronic filing, mail the original and one copy of the complaint with the $405 filing and administrative fees or the application to proceed in forma pauperis to:

1 Revised 11/6/24 Phoenix & Prescott Divisions: OR Tucson Division: U.S. District Court Clerk U.S. District Court Clerk U.S. Courthouse, Suite 130 U.S. Courthouse, Suite 1500 401 West Washington Street, SPC 10 405 West Congress Street Phoenix, Arizona 85003-2119 Tucson, Arizona 85701-5010

7. Change of Address. You must immediately notify the Court and the defendants in writing of any change in your mailing address. Failure to notify the Court of any change in your mailing address may result in the dismissal of your case.

8. Certificate of Service. You must furnish the defendants with a copy of any document you submit to the Court (except the initial complaint and application to proceed in forma pauperis). Each original document (except the initial complaint and application to proceed in forma pauperis) must include a certificate of service on the last page of the document stating the date a copy of the document was mailed to the defendants and the address to which it was mailed. See Fed. R. Civ. P. 5(a), (d). Any document received by the Court that does not include a certificate of service may be stricken. This section does not apply to inmates housed at an Arizona Department of Corrections facility that participates in electronic filing. A certificate of service should be in the following form:

I hereby certify that a copy of the foregoing document was mailed this (month, day, year) to: Name: Address: Attorney for Defendant(s)

(Signature)

9. Amended Complaint. If you need to change any of the information in the initial complaint, you must file an amended complaint. The amended complaint must be written on the court- approved civil rights complaint form. You may file one amended complaint without leave (permission) of Court within 21 days after serving it or within 21 days after any defendant has filed an answer, whichever is earlier. See Fed. R. Civ. P. 15(a). Thereafter, you must file a motion for leave to amend and lodge (submit) a proposed amended complaint. LRCiv 15.1. In addition, an amended complaint may not incorporate by reference any part of your prior complaint. LRCiv 15.1(a)(2). Any allegations or defendants not included in the amended complaint are considered dismissed. All amended complaints are subject to screening under the Prison Litigation Reform Act; screening your amendment will take additional processing time.

10. Exhibits. You should not submit exhibits with the complaint or amended complaint. Instead, the relevant information should be paraphrased. You should keep the exhibits to use to support or oppose a motion to dismiss, a motion for summary judgment, or at trial.

11. Letters and Motions. It is generally inappropriate to write a letter to any judge or the staff of any judge. The only appropriate way to communicate with the Court is by filing a written pleading or motion.

2 12. Completing the Civil Rights Complaint Form.

HEADING: 1. Your Name. Print your name, prison or inmate number, and institutional mailing address on the lines provided.

2. Defendants. If there are four or fewer defendants, print the name of each. If you name more than four defendants, print the name of the first defendant on the first line, write the words “and others” on the second line, and attach an additional page listing the names of all of the defendants. Insert the additional page after page 1 and number it “1- A” at the bottom.

3. Jury Demand. If you want a jury trial, you must write “JURY TRIAL DEMANDED” in the space below “CIVIL RIGHTS COMPLAINT BY A PRISONER.” Failure to do so may result in the loss of the right to a jury trial. A jury trial is not available if you are seeking only injunctive relief.

Part A. JURISDICTION: 1. Nature of Suit. Mark whether you are filing the complaint pursuant to 42 U.S.C. ' 1983 for state, county, or city defendants; “Bivens v. Six Unknown Federal Narcotics Agents” for federal defendants; or “other.” If you mark “other,” identify the source of that authority.

2. Location. Identify the institution and city where the alleged violation of your rights occurred.

3. Defendants. Print all of the requested information about each of the defendants in the spaces provided. If you are naming more than four defendants, you must provide the necessary information about each additional defendant on separate pages labeled “2-A,” “2-B,” etc., at the bottom. Insert the additional page(s) immediately behind page 2.

Part B. PREVIOUS LAWSUITS: You must identify any other lawsuit you have filed in either state or federal court while you were a prisoner. Print all of the requested information about each lawsuit in the spaces provided. If you have filed more than three lawsuits, you must provide the necessary information about each additional lawsuit on a separate page. Label the page(s) as “2-A,” “2-B,” etc., at the bottom of the page and insert the additional page(s) immediately behind page 2.

Part C. CAUSE OF ACTION: You must identify what rights each defendant violated. The form provides space to allege three separate counts (one violation per count). If you are alleging more than three counts, you must provide the necessary information about each additional count on a separate page. Number the additional pages “5-A,” “5-B,” etc., and insert them immediately behind page 5. Remember that you are limited to a total of fifteen additional pages.

3 1. Counts. You must identify which civil right was violated. You may allege the violation of only one civil right per count.

2. Issue Involved. Check the box that most closely identifies the issue involved in your claim. You may check only one box per count. If you check the box marked “Other,” you must identify the specific issue involved.

3. Supporting Facts. After you have identified which civil right was violated, you must state the supporting facts. Be as specific as possible. You must state what each individual defendant did to violate your rights. If there is more than one defendant, you must identify which defendant did what act. You also should state the date(s) on which the act(s) occurred, if possible.

4. Injury. State precisely how you were injured by the alleged violation of your rights.

5. Administrative Remedies. You must exhaust any available administrative remedies before you file a civil rights complaint. See 42 U.S.C. § 1997e. Consequently, you should disclose whether you have exhausted the inmate grievance procedures or administrative appeals for each count in your complaint. If the grievance procedures were not available for any of your counts, fully explain why on the lines provided.

Part D. REQUEST FOR RELIEF: Print the relief you are seeking in the space provided.

SIGNATURE: You must sign your name and print the date you signed the complaint. Failure to sign the complaint will delay the processing of your action. Unless you are an attorney, you may not bring an action on behalf of anyone but yourself.

FINAL NOTE

You should follow these instructions carefully. Failure to do so may result in your complaint being stricken or dismissed. All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number the pages.

4 ___________________________________________ Name and Prisoner/Booking Number ___________________________________________ Place of Confinement ___________________________________________ Mailing Address ___________________________________________ City, State, Zip Code (Failure to notify the Court of your change of address may result in dismissal of this action.)

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF ARIZONA

_________________________________________ , (Full Name of Plaintiff)

Plaintiff, v. CASE NO. __________________________________ (To be supplied by the Clerk) (1) _______________________________________ , (Full Name of Defendant) CIVIL RIGHTS COMPLAINT (2) _______________________________________ , BY A PRISONER

(3) _______________________________________ , G Original Complaint (4) _______________________________________ , G First Amended Complaint G Second Amended Complaint Defendant(s).

G Check if there are additional Defendants and attach page 1-A listing them.

A. JURISDICTION

1. This Court has jurisdiction over this action pursuant to: G 28 U.S.C. § 1343(a); 42 U.S.C. § 1983 G 28 U.S.C. § 1331; Bivens v. Six Unknown Federal Narcotics Agents, 403 U.S. 388 (1971). G Other: .

2. Institution/city where violation occurred: .

550/555 B. DEFENDANTS

1. Name of first Defendant: . The first Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

2. Name of second Defendant: . The second Defendant is employed as: as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

3. Name of third Defendant: . The third Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

4. Name of fourth Defendant: . The fourth Defendant is employed as: ______________________________________________ at_______________________________________. (Position and Title) (Institution)

If you name more than four Defendants, answer the questions listed above for each additional Defendant on a separate page.

C. PREVIOUS LAWSUITS

1. Have you filed any other lawsuits while you were a prisoner? G Yes G No

2. If yes, how many lawsuits have you filed? . Describe the previous lawsuits:

a. First prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .

b. Second prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .

c. Third prior lawsuit: 1. Parties: v. 2. Court and case number: . 3. Result: (Was the case dismissed? Was it appealed? Is it still pending?) .

If you filed more than three lawsuits, answer the questions listed above for each additional lawsuit on a separate page. D. CAUSE OF ACTION

COUNT I 1. State the constitutional or other federal civil right that was violated: .

2. Count I. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts. State as briefly as possible the FACTS supporting Count I. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.

.

4. Injury. State how you were injured by the actions or inactions of the Defendant(s).

.

5. Administrative Remedies: a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count I? G Yes G No c. Did you appeal your request for relief on Count I to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .

3 COUNT II 1. State the constitutional or other federal civil right that was violated: .

2. Count II. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts. State as briefly as possible the FACTS supporting Count II. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.

.

4. Injury. State how you were injured by the actions or inactions of the Defendant(s).

.

5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count II? G Yes G No c. Did you appeal your request for relief on Count II to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .

4 COUNT III 1. State the constitutional or other federal civil right that was violated: .

2. Count III. Identify the issue involved. Check only one. State additional issues in separate counts. G Basic necessities G Mail G Access to the court G Medical care G Disciplinary proceedings G Property G Exercise of religion G Retaliation G Excessive force by an officer G Threat to safety G Other: .

3. Supporting Facts. State as briefly as possible the FACTS supporting Count III. Describe exactly what each Defendant did or did not do that violated your rights. State the facts clearly in your own words without citing legal authority or arguments.

.

4. Injury. State how you were injured by the actions or inactions of the Defendant(s).

.

5. Administrative Remedies. a. Are there any administrative remedies (grievance procedures or administrative appeals) available at your institution? G Yes G No b. Did you submit a request for administrative relief on Count III? G Yes G No c. Did you appeal your request for relief on Count III to the highest level? G Yes G No d. If you did not submit or appeal a request for administrative relief at any level, briefly explain why you did not. .

If you assert more than three Counts, answer the questions listed above for each additional Count on a separate page.

5 E. REQUEST FOR RELIEF

State the relief you are seeking:

.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on DATE SIGNATURE OF PLAINTIFF

___________________________________________ (Name and title of paralegal, legal assistant, or other person who helped prepare this complaint)

___________________________________________ (Signature of attorney, if any)

___________________________________________ (Attorney=s address & telephone number)

ADDITIONAL PAGES

All questions must be answered concisely in the proper space on the form. If you need more space, you may attach no more than fifteen additional pages. But the form must be completely filled in to the extent applicable. If you attach additional pages, be sure to identify which section of the complaint is being continued and number all pages.